Healthcare Provider Details

I. General information

NPI: 1619097854
Provider Name (Legal Business Name): REBOUND PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 SW VETERANS WAY SUITE 4
REDMOND OR
97756-2564
US

IV. Provider business mailing address

805 SW INDUSTRIAL WAY SUITE 3
BEND OR
97702-1093
US

V. Phone/Fax

Practice location:
  • Phone: 541-504-2350
  • Fax: 541-504-2354
Mailing address:
  • Phone: 541-585-2529
  • Fax: 541-585-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0965535-8
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0965535-8
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER RICHARDSON
Title or Position: COMPLIANCE COORDINATOR
Credential:
Phone: 541-585-2529